title: Autonomic shift and increased susceptibility to infections after acute intracerebral hemorrhage.
abstract: OBJECTIVE
  High infection rate after severe stroke may partly relate to brain-induced immunodepression syndrome. However, the underlying pathophysiology remains unclear. The aim of the current study was to investigate the role of autonomic shift in increased susceptibility to infection after acute intracerebral hemorrhage (ICH).
  
  
  METHODS
  We retrospectively analyzed 62 selected patients with acute ICH from our prospective database. Autonomic shift was assessed using the cross-correlational baroreflex sensitivity (BRS). The occurrence and cause of in-hospital infections were assessed based on the clinical and laboratory courses. Demographic and clinical data including initial stroke severity, hemorrhage volume, intraventricular blood extension, history of aspiration, and invasive procedures such as mechanical ventilation, surgical hematoma evacuation, external ventricular drainage, central venous and urinary catheters, and nasogastric feeding were recorded and included in the analysis.
  
  
  RESULTS
  We identified 36 (58%) patients with infection during the first 5 days of hospital stay. Patients with infections had significantly lower BRS, higher initial NIHSS scores, larger hemorrhages, and more frequently had intraventricular blood extension and underwent invasive procedures. In the multivariate regression model, decreased BRS (OR, 0.54; 95% CI, 0.32-0.91; P=0.02) and invasive procedures (OR, 2.32; 95% CI, 1.5-3.6; P<0.001) remained independent predictors for an infection after ICH.
  
  
  CONCLUSIONS
  Decreased BRS was independently associated with infections after ICH. Autonomic shift may play an important role in increased susceptibility to infections after acute brain injury including ICH. The possible therapeutic relevance of autonomic modulation warrants further studies.
authors.affiliation: Department of Neurology, University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. marek.sykora@med.uni-heidelberg.de
authors.forename: Marek
authors.initials: M
authors.lastname: Sykora
authors.forename: Jennifer
authors.initials: J
authors.lastname: Diedler
authors.forename: Sven
authors.initials: S
authors.lastname: Poli
authors.forename: Timolaos
authors.initials: T
authors.lastname: Rizos
authors.forename: Peter
authors.initials: P
authors.lastname: Turcani
authors.forename: Roland
authors.initials: R
authors.lastname: Veltkamp
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steiner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017704:Baroreflex / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000503:physiopathology*; D003428:Cross Infection / Q000453:epidemiology* / Q000503:physiopathology*; D004198:Disease Susceptibility / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult